1 Pregnancy Guide Teachers Federation Health Ltd. ABN trading as UniHealth Insurance. A Registered Private Health Insurer.
3 Thinking about having a baby? Does your current policy cover pregnancy and birth related services? Will you have to pay an excess on your current cover? When you start planning a family with your partner, you need to think about your health cover. If you want to be covered for obstetrics (pregnancy and birth related services) in a private hospital with an obstetrician of your choice, you need to take out Private Hospital cover or upgrade your existing membership well before you are pregnant, as waiting periods will apply. Your Private Hospital cover kicks in once you are admitted into hospital. You need to be aware that out-of-hospital medical expenses incurred throughout your pregnancy (scans, obstetrician appointments, blood tests etc) will not be covered by your private health insurance although they may be covered to some extent by Medicare. Check if you are eligible for additional Medicare benefits with the Medicare Safety Net (see page 15). Pregnancy Guide 3
4 Step 1 Pregnancy Guide 4
5 Choose the right product for you Top Hospital Top Hospital is an appropriate level of cover for pregnancy and birth related services. If you are on Top Hospital and your chosen hospital has an agreement with UniHealth Insurance, you will be covered in a private hospital for: Accommodation, labour ward, theatre and intensive care fees. Private or shared room (subject to availability). Obstetrician / surgeon / specialist fees (for services provided in hospital as an admitted patient). Access Gap Cover - if your doctor charges you under this scheme, your out-of-pocket expenses may be reduced or eliminated (see page 11). Emergency Ambulance Transport. Check if your hospital has an agreement with UniHealth Insurance at unihealthinsurance.com.au or call us on If your chosen hospital does not have an agreement, you will be covered up to the default rate (set by the Federal Government) and will incur significant out-of-pocket expenses.
6 Mid Hospital & Basic Hospital If you have Mid Hospital cover or Basic Hospital you will be covered in a public hospital for: Accommodation, labour ward, theatre and intensive care fees Shared room Obstetrician / surgeon / specialist fees (for services provided in hospital as an admitted patient) Access Gap Cover - if your doctor charges you under this scheme, your out-of-pocket expenses may be reduced or eliminated (see page 11) Emergency Ambulance Transport StarterPak If you have StarterPak, you will not be covered for pregnancy and birth related services in a private or public hospital. Will I have waiting periods to serve? There is a nine month waiting period for all pregnancy and birth related services. This means you need to have held an appropriate level of cover for at least nine months before you are admitted to hospital to have your baby. Check your waiting period status by logging into your membership via Member Area at unihealthinsurance.com.au or calling Will I have to pay an excess? If you have Top Hospital Nil Excess, no excess is payable. If you have Top Hospital 300 or 500, Mid Hospital or Basic Hospital, you will have an excess to pay towards your admission. (see page 7) Pregnancy Guide 6
7 Hospital cover Excess payable Private Hospital cover Top Hospital Top Hospital 300 Top Hospital 500 No excess. $300 per person, per calendar year. The excess is paid once per person, per calendar year to a maximum of twice per membership, for family and couple memberships. This excess is only payable when admitted to a private hospital. Please note: excess does not apply to dependants under the age of 21. $500 per person, per calendar year. The excess is paid once per person, per calendar year to a maximum of twice per membership, for family and couple memberships. This excess is only payable when admitted to a private hospital. Please note: excess does not apply to dependants under the age of 21. Public Hospital cover Mid Hospital 300 Mid Hospital 500 Basic Hospital $300 per person, per calendar year. The excess is paid once per person, per calendar year to a maximum of twice per membership, for family and couple memberships. This is payable when you are admitted to a private or public hospital. Please note: If you choose to deliver in a private hospital, significant out-of-pocket expenses will be incurred. Mid Hospital only provides pregnancy cover in a public hospital. $500 per person, per calendar year. The excess is paid once per person, per calendar year to a maximum of twice per membership, for family and couple memberships. This is payable when you are admitted to a private or public hospital. Please note: If you choose to deliver in a private hospital, significant out-of-pocket expenses will be incurred. Mid Hospital only provides pregnancy cover in a public hospital. $300 per person, per calendar year. The excess is paid once per person, per calendar year to a maximum of twice per membership, for family and couple memberships. This is payable when you are admitted to a private or public hospital. Please note: If you choose to deliver in a private hospital, significant out-of-pocket expenses will be incurred. Basic Hospital only provides pregnancy cover in a public hospital.. No cover StarterPak Pregnancy is not covered. Pregnancy Guide 7
8 Step 2 Pregnancy Guide 8
9 Choose an obstetrician How do I choose an obstetrician? Ask your GP for a list of obstetricians in your area. We recommend that you give them a call and ask them the following questions: 1. Are you taking any more patients? 2. At which hospitals do you deliver? 3. Is that a public or private hospital? 4. Can you provide me with a rough guide as to the fees you charge for planning and managing my pregnancy? 5. Do you participate in the Access Gap Cover scheme? 6. What arrangements do you have in place if you are away at the time of the delivery? Contact us and ask: If the hospitals your obstetrician works at hold an agreement with UniHealth Insurance. If you elect to have your baby in a hospital that does not hold an agreement with us, you will have significant out-ofpocket expenses. Whether the obstetrician has participated in Access Gap Cover before. If they have, they may consider charging you under the Access Gap Cover scheme which will eliminate or significantly reduce your out-of-pocket expenses. Or visit unihealthinsurance.com.au Ask your obstetrician for a quote Obtain a quote (known as Informed Financial Consent) from your obstetrician so you are aware of the charges payable throughout your pregnancy. Remember that any services received while you are not admitted in hospital may only be partially covered by Medicare. You should discuss with your obstetrician if he/she will bill you under the Access Gap Cover scheme for services received when you are admitted to hospital (to give birth).
10 Step 3 Pregnancy Guide 10
11 Ask about the Access Gap Cover (AGC) scheme Access Gap Cover (AGC) is a billing scheme that aims to reduce or eliminate out-of-pocket expenses incurred by doctor and specialist services received in hospital as an inpatient. AGC allows us to pay above the scheduled fee for services provided to you as an inpatient, covering the entire doctor s fee or leaving you with significantly reduced out-of-pocket expenses. If your obstetrician chooses to participate in AGC, they must provide you with a written estimate of fees for the cost of the services throughout your pregnancy. Doctors can choose to participate in AGC on a patient-by-patient basis, so you should discuss this with your doctor. If your doctor charges the AGC fee, you will have nothing to pay. If they charge above the AGC fee you will be able to establish the known gap that you will have to pay before you receive treatment. The checklist overleaf will help you to reduce your out-of-pocket expenses, or determine the possible out-of-pocket expenses. Pregnancy Guide 11
12 Asking your obstetrician if they will participate in the Access Gap Cover (AGC) scheme Will the fee you charge me be covered under AGC or will I have to pay a known gap? If there is a gap amount, can you provide me with an Informed Financial Consent document so I know exactly how much I will be out-of-pocket? Can you provide me with the relevant Medicare Benefits Schedule (MBS) Item numbers, so I can discuss these with UniHealth Insurance and/or Medicare? Will any assisting doctors involved in helping me give birth, including anaesthetist, assistant surgeon, paediatrician and pathologist, treat me under AGC? What out-of-pocket expenses, if any, will there be for their services? Can you send the bill directly to UniHealth Insurance, so that they can claim the Medicare benefit on my behalf and send the payment back to you? Pregnancy Guide 12
13 Other information What out-of-pocket expenses might I have? A hospital excess paid upon admission to hospital (depending on your level of cover). Anaesthetist (if you have an epidural or a caesarean section) if they do not participate in the AGC scheme. Any assisting specialists (e.g. assisting surgeon if you require a caesarean) that do not participate in the AGC scheme. If your baby receives treatment in the hospital and is not an admitted patient (e.g. paediatric check-up). Pharmaceuticals that are not covered in the agreement with the hospital or that are listed under the Pharmaceutical Benefits Scheme. For visits to your obstetrician and any tests or scans before and after you go to hospital: Medicare pays 85% of the MBS fee, you pay the remainder of the account. For treatment in hospital when an admitted patient: Medicare pays 75% of the MBS fee, UniHealth Insurance pays 25% of the MBS fee. Then, you pay the remainder of the account (unless the specialist providing the treatment participates in AGC). After the baby arrives When you are settled in and have a few moments to spare, give us a call on or log on to the Member Area at unihealthinsurance.com.au and add your baby to your cover. We will need the name, date of birth and sex of your baby for them to be covered with no waiting periods. All waiting periods will be waived for your baby if you add him/ her to your membership within two months of the birth of your child. Please note: If you are on a single membership, you will need to upgrade to a family or single parent membership, within 2 months, to add your baby to your cover and avoid any waiting periods. Pregnancy Guide 13
14 Frequently asked questions 1. What happens if I am considering getting pregnant but I m on a Hospital cover that excludes or restricts pregnancy or birth related services, and I want to give birth in a private hospital? It s important you have Hospital cover that includes pregnancy benefits, such as Top Hospital. A nine month waiting period applies for all services relating to pregnancy and childbirth. This means, you will need to have held Top Hospital well in advance of your pregnancy. 2. What happens if my baby is premature and I have not served my waiting periods? If your baby comes early and you are still within the nine month waiting period you will not be entitled to benefits under your private hospital cover. For this reason, UniHealth Insurance recommends taking out or upgrading to a cover that covers pregnancy well in advance of your pregnancy. 3. What if my baby is premature and I am required to give birth in a public hospital, even though I am booked to give birth in a private hospital? You may be admitted as a private patient in a public hospital. You will not be guaranteed a private room. However, if a private room is available or becomes available during your stay, you may be relocated to the available room. This decision is dependent on the hospital and is not controlled or influenced by UniHealth Insurance. 4. What happens if I have Hospital cover that includes pregnancy, but I become pregnant while I am on a single membership? If you have a single membership, you will still be covered during your pregnancy and at the birth of your baby. Once your baby is born, you will need to upgrade to a family or single parent membership. This is particularly important if your baby is admitted to hospital. Simply call us on or login to the Member Area at unihealthinsurance.com.au You will need to advise us of the name, date of birth and sex of your baby. Pregnancy Guide 14
15 5. When is my baby an admitted patient? Babies born without complications are generally not admitted to hospital, but treated as an out-patient. A newborn baby is classified as an inpatient when one or more of the following criteria are met: The baby is admitted to an approved neo-natal intensive care facility. The baby is the second or subsequent born in a multiple birth situation (i.e. twins or triplets). The baby is more than 10 days old when still in hospital. 6. What do I need to do if my baby is admitted to hospital? After giving birth, your main focus will be on your own recovery and the health of your newborn baby. However, if your baby is admitted to hospital, he/she will need to be added to your cover as soon as possible (within two months) to ensure that a claim can be made for the costs incurred during that time. 7. What happens if my baby is not admitted to hospital but still receives treatment? Benefits will only be available through Medicare. Medicare will cover 85% of the Medicare Benefits Schedule (MBS) fee. Benefits are not available from UniHealth Insurance when your baby is not an admitted patient in the hospital. 8. Does UniHealth Insurance pay benefits for antenatal and postnatal courses? Antenatal and postnatal classes conducted outside of a hospital may be covered if you have Top Extras cover. Please contact us on for further information. Some hospitals offer postnatal classes in conjunction with your hospital admission and accommodation costs. These costs are covered by UniHealth Insurance if you have Private Hospital cover. Eligibility criteria applies. 9. What is the Medicare Safety Net? The Medicare Safety Net provides families and individuals with financial assistance for high out-of-pocket expenses for out-ofhospital Medicare Benefits Schedule (MBS) fees. Once you meet a Medicare Safety Net threshold, you may be eligible for additional Medicare benefits for out-of-hospital MBS services for the rest of the calendar year. You can register for the Medicare Safety Net for free at medicareaustralia.gov.au. This allows Medicare to track your out-of-hospital, out-of pocket expenses and advise you when you are nearing the threshold. Pregnancy Guide 15
16 10. Why won t my doctor participate in the Access Gap Cover (AGC) scheme? It is up to your doctor to decide whether to charge you under the AGC scheme. Even if the doctor has previously participated in this scheme, it does not guarantee that the doctor will participate for your treatment. Doctors are free to choose on a patient-by-patient basis. This decision remains solely with the doctor. 11. What might I have to pay for during my hospital stay? There are services that you may receive in hospital that are not covered by us. These include: Telephone and internet usage charges. TV hire or other items of a non-medical nature. Pharmaceuticals that are not covered in the agreement with the hospital or that are listed under the Pharmaceuticals Benefits Scheme (PBS). 12. Can I receive benefits towards home nursing after a hospitalisation? If you have Top Extras cover you may receive benefits towards home visits by a registered nurse in a private practice. 13. Does UniHealth Insurance pay a benefit for one-on-one lactation nursing? If you have Top Extras cover you may receive benefits towards one-on-one lactation nursing received from a recognised provider. 14. Does UniHealth Insurance pay a benefit for support/surgical stockings or compression garments? Some women may be required to wear surgical stockings or compression garments during their pregnancy to prevent or minimise varicose veins. If you have Top Extras cover, a benefit may be payable if your doctor or obstetrician recommends you to wear surgical stockings. However, written evidence must be provided to UniHealth Insurance. Please note: compression garments must have a compression grade or class greater than 1 (compression greater than 30mm Hg). Pregnancy Guide 16
17 For more information, contact us on Pregnancy Guide 17
18 Parent & Infant Program * Supporting you in pregnancy and parenting UniHealth Insurance has formed a partnership with the Parent-Infant Research Institute (PIRI) to bring you our Parent & Infant Program. PIRI is Australia s largest research centre for perinatal depression and a leader in early intervention treatment programs for perinatal depression and helping parents make the transition to parenthood. The program covers a range of important areas that aren t normally covered in routine antenatal classes and is administered by trained health professionals. How does it work? The Parent & Infant Program gives you access to PIRI s services including: Before the birth you will be sent, The Towards Parenthood Self-Help Workbook. After the birth, contact PIRI to access a range of services and support. This could include consultation and support over the phone or , telephonic counselling, face-to-face counselling, including individual or group treatment, referral to suitable services including face-to-face assessments with clinical psychologists, and liaison with external providers. Interested? If you are pregnant, let us know by calling so we can introduce you to the program at the start of your pregnancy. We will also be reviewing cover checks done by hospitals to identify any members who are pregnant and will send them the book and information about the program. The Parent & Infant Program is available at no additional cost to eligible members who have Hospital or Combined cover (excluding StarterPak). Your eligibility will be confirmed when you notify the Fund of your pregnancy. * This program is not intended to replace the clinical advice of your doctor or health care provider. You should consult your doctor for specialist medical advice if you have any concerns about your pregnancy. Eligibility criteria applies. Pregnancy Guide 18
19 More information For more information, including the full eligibility criteria visit unihealthinsurance.com.au or piri.org.au. Alternatively, contact PIRI between 9am 5pm, Monday to Friday AEST on Pregnancy Guide 19
20 Did you know? Dental A pregnant woman s unique diet during pregnancy can sometimes cause dental diseases. The frequency of meals and gastric acids (due to vomiting when experiencing morning sickness) can cause erosion of the tooth surface. A diet low in sugar and acidity is recommended to reduce the risk of tooth decay. A pregnant woman runs an increased risk of gingivitis during pregnancy. This is caused by an excess of bacterial plaque compounded by hormonal changes. Good oral hygiene is highly recommended to prevent this. So if you have Extras cover, have a dental check-up before you are planning to have a baby or after you conceive. Don t forget to tell your dentist if you re pregnant, or planning to be, as x-rays may not be safe at this time. Eyecare It is recommended to have a comprehensive eye examination during pregnancy, especially for women with conditions such as diabetes (including gestational diabetes), high blood pressure, or a family history of glaucoma. During pregnancy, women can experience the following changes to their vision: Prescription changes this can be temporary or permanent. If your prescription changes during your pregnancy, we recommend that you be re-examined at some point after the delivery of your baby or once you finish breast feeding. Dry eyes especially if you wear contact lenses. This can be treated with eye drops. Pregnancy Guide 20
21 Massage Remedial or prenatal massages are great for back pain. There are some essential oils that are beneficial during pregnancy, however, there are some which should be avoided for their contraction stimulating properties. These include arnica, clary sage, fennel, jasmine and juniper. Be sure to check with a qualified therapist before using any essential oils during a massage while you are pregnant. Dealing with morning sickness There are several remedies you can try to help relieve morning sickness - some of which are listed below. You may also be able to claim a benefit for these services from your UniHealth Insurance Extras cover. It is important that you talk to your obstetrician or midwife before you try any of the following remedies. Also ensure that the service providers are experienced in dealing with pregnant women. Acupuncture consult a qualified practitioner such as a member of the Australian Acupuncture and Chinese Medicine Association (AACMA). Hypnosis while there s no definitive evidence that it helps with morning sickness, it has been shown to be effective in combating nausea during chemotherapy. Reflexology can reduce stress and anxiety, which can cause conditions in pregnancy, labour and in the post natal period. Homeopathy can increase well-being prior to pregnancy, improve the chances of conception, treat morning sickness during pregnancy, post-partum bruising of mother and newborn infant, breast feeding problems and postnatal depression. HealthMeasures HealthMeasures is an online health management service that UniHealth Insurance members can access for free. The online library provides a number of interesting articles relating to pregnancy that you will find both valuable and educational. Log in or sign up to HealthMeasures via unihealthinsurance.com.au. If you have further questions, or are unsure of anything you have read in this brochure, please contact us on Pregnancy Guide 21
22 It doesn t hurt to ask. Your pregnancy should be an enjoyable experience. Please contact us if you have any questions - we are here to help you. Call or Alternatively, you can direct your questions to your obstetrician or the hospital where you are scheduled to have your baby. They will be able to tell you what paperwork to take to Medicare and what to give UniHealth Insurance. Pregnancy Guide 22
23 Notes Pregnancy Guide 23